Interventional Radiology

• These are highly sophisticated medical procedures do not involve large incisions and therefore are much less invasive and many a times replace complicated and painful open surgical procedures.
• In majority of cases general anesthesia usually is not required.
• Thus risk, pain and recovery time are often significantly reduced.
• Most procedures can be performed on an outpatient basis or require only a short hospital stay and therefore.
• The procedures are sometimes less expensive than surgery or other alternatives.

• Drain insertions: At one time, surgery was required for people who required a feeding tube or a tube to drain an infection, but today these procedures can be done without surgery by an interventional radiologist. This is a procedure in which a tube is placed through the skin into different parts of the body to drain fluids. E.g. in urine obstruction because of stones, and in biliary system for obstructive jaundice. A suitable stent if necessary may be placed a few days after the drainage to help hold open the obstruction in natural tract so as to drain the fluid inside the body. (Fig 2 a and b)
• Radiofrequency ablation (RF/RFA): A localized destruction of tissue (e.g., tumors) by heating e.g. liver, bone tumor like osteoid osteoma etc.
• Vertebroplasty: This is an image-guided, minimally invasive, nonsurgical therapy, involves percutaneous injection of biocompatible bone cement inside fractured/compressed vertebrae (spinal bone), to strengthen a broken vertebra that has been weakened by osteoporosis or, less commonly, cancer. It is usually successful at alleviating the pain caused by a compression fracture. It can increase the patient functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. (Fig 3)
• Ozone treatment: This is relatively a new treatment where freshly prepared ozone gas is injected into the spine. This is for disc herniation and patient is relived of pain.

• Diagnostic Angiography: A method of imaging the blood vessels to look for abnormalities, in which a contrast agent (dye) is injected into the blood stream and followed by x-ray. Areas of abnormalities/blockage can easily be seen. (Fig 6)
• Balloon angioplasty/stent: opening of narrow or blocked blood vessels using a balloon, to improve blood flow in the body’s arteries. The radiologist takes a balloon-tipped catheter (a thin, plastic tube) to the site of a narrow or blocked artery and then inflates the balloon to open the vessel. The balloon is then deflated and removed from the artery. Vascular stenting, often performed at the same time as an angioplasty, involves the placement of a small wire mesh tube called a stent in the newly opened artery. (Fig 2). This procedure is done for various arteries or veins anywhere in the body, may be in brain or in legs. (Fig 5 and 8).
• Endograft repair of arterial aneurysms - An aneurysm is a weakening in the wall of an artery. An endograft repair is a technique in which a catheter is inserted into a blood vessel under x-ray guidance. An endograft (a fabric tube) is inserted through the catheter and moved to the site of the aneurysm, where it is expanded, reinforcing the vessel and thus establishing the normal pathway for the blood. (Fig 9 and 11).
• Thrombolysis: treatment aimed at dissolving blood clots (e.g., pulmonary emboli, leg vein thrombi, thrombosed hemodialysis accesses) with both drugs (urokinase etc) and mechanical means.
• Venous access: This involves insertion and management of specialized kinds of intravenous devices (IVs) (e.g. PICC lines, Hickman lines, subcutaneous ports) for administering long or short-term medications.
• Dialysis access/intervention: Establishing and maintaining vascular access (site on the body where blood is removed and returned), for hemodialysis patients. It involves placement of tunneled hemodialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.
• TIPS: This involves placement of a Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for management of select patients with complications of severe liver diseases and portal hypertension as a less-invasive alternative to surgery.

• Embolization: blocking abnormal blood (artery) vessels (e.g., for the purpose of stopping bleeding) or organs (to stop the extra function e.g. embolization of the spleen for hypersplenism) including uterine artery embolization for percutaneous treatment of uterine fibroids. Various embolic agents are used, including gelfoam alcohol, glue, metallic coils, polyvinyl alcohol particles, and. Embospheres. (Fig 4)
• Chemoembolization: delivering cancer treatment directly to a tumor through its blood supply, then using clot-inducing substances to block the artery, ensuring that the delivered chemotherapy is not “washed out” by continued blood flow. This is generally done on an outpatient basis and requires only sedation, not general anesthesia.
• Endovenous laser ablation of varicose veins: This is non-surgical treatment of venous insufficiency. IR places a thin tube into the vein. Once inside, the tube sends out radiofrequency or laser energy that shrinks and seals the vein wall and symptoms from the varicose vein improve. Veins on the surface of the skin that are connected to the treated varicose vein will also usually shrink after treatment. The normal healthy veins around the closed vein restore the normal flow of blood.
• IVC filters: IVC stands for inferior vena cava, a major blood vessel that returns blood from the lower body to the heart. An IVC filter is a small piece of metal that can be put into the IVC to prevent blood clots in the legs from going up to the lungs so as to prevent complications like lung damage. (Fig 10)
• Biopsy: taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transjugular approach, without the need for surgery.
• Intravascular foreign body retrieval: With minimal invasive and non-surgical technique and with help of delicate and dedicated instruments, IR can remove the foreign body like broken pieces of catheters etc., from the arteries or veins.

• Will it hurt?
  There can be some discomfort. Local anesthetic (numbing medicine) or sedation is used as needed. Often you will feel heat and pressure from the dye.
• For how much time will I be required to stay in the hospital?
  It depends on the type or procedure. For diagnostic Angiography, you will be needed to stay for 6 hours after the procedure is over.
  Some therapeutic procedures are performed on outpatient basis, and you can go home same day, however for other procedures like embolization and stenting, 1 to 3 days hospital stay is required.
• Is this treatment costly?
  The materials used for these procedures are expensive and more or less all these are ordered from foreign countries, so at the beginning the interventional procedures are sometimes expensive than surgery or other alternatives. However with IR procedures large incision is not needed, so hospital stay is either not required or reduced, patient can soon start his normal day to day activities and go back to earn his livelihood. Further expensive medicines are often not needed. So taking all these into account, IR procedures are less expensive.
• Are there any Limitations/disadvantages of this treatment option? Why these treatment options are not available very commonly?
  These are highly sophisticated medical procedures performed by skilled radiologists under the guidance of very expensive machines. Therefore these treatments are operator dependent and require state of the art machines for good resolution so as to help the IR to reach the diseased part as close as possible. Further to a certain extent, these treatments are anatomy dependent and so sometimes it becomes difficult for IR to reach superselctively and offer suitable treatment. In such cases open surgical treatment option is available to you.
• How do I know if I am the candidate for Interventional radiological treatment option?
  Whenever you are advised any treatment, you may ask your family doctor or referring physician or interventional radiologist “Is there any alternative minimal invasive treatment option available to me.”

• Contact at the address mentioned below
• Visit http://www.sirweb.org (Society of Cardiovascular and Interventional Radiologists or http://www.isvir.in (Indian Society of Vascular & Interventional Radiology)